Medicare Doghnut Hole!

Discussion in 'Off-topic' started by CountryGun, Dec 5, 2010.

  1. CountryGun

    CountryGun New Member

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    My mother resides in an assisted living facility in North Carolina. The fees for her living there consume every penny she has in income, and I pay several thousand that is not covered. She literally has no money. We were up there over the weekend, and I think she had four dollars cash. We cover her other needs too, and get her hair done. She's happy, and she's made many friends.

    Now, Social Security writes that her income ($20,000 from my deceased dad's pension, and Social security) is above the maximum income of just over $16,000 (resulting in the infamous "doughnut hole". As a result, Medicare will no longer cover her prescriptions, so my sister and myself must come up with another $700 per month! She never see's that $20,000. It goes straight to the home, and doesn't cover the bill!

    I need to know if anyone else has experienced this, and maybe has found a way around this abuse. I've wondered if there might be a way to get prescriptions filled at Wal-Mart, under their $4.00 per prescription deal, or any other ideas? It would seem that Social Security would understand that my mother has no real income, and that every penny goes to the facility that cares for her, but they don't. :evil: Any and all help will be appreciated. :help:
     
  2. rmodel65

    rmodel65 Yukon Cornelius

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    some prescriptions at publix are completely free....
     

  3. CountryGun

    CountryGun New Member

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    Thanks! I didn't know that. One of the problems inherent is the fact that the "home" won't take prescriptions unless they're direct from a pharmacy, so picking them up and dropping them off is out of the question. Some will deliver, and that may be good enough.
     
  4. CoffeeMate

    CoffeeMate Junior Butt Warmer

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    Get this on the national media ASAP. Frame it as the truth about "hope" and "change" and governmental "compassion". Blare it from the rooftops.


    I'm serious.

    I can not believe your mother is the only person this is happening to. Awareness needs to be raised about this outrage.
     
  5. mb90535im

    mb90535im Well-Known Member

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    It's happening to lots of folks, something like 3.4 million in 2007.

    (google medicare donut hole)

    The health care reform act will gradually help close the hole, but it doesn't reach full impact until something like the year 2020.

    The "hole" itself refers to a gap in coverage where prescription cost reach a certain threshold and before reaching another.

    Here is some good info that explains it and mentions possible solutions with alternative Part D plans.

    http://blog.medicare.gov/2010/08/09/wha ... C2%A0hole/


    [​IMG]
     
  6. budder

    budder Moderator Staff Member

    Is there a cheaper home available?
     
  7. CoffeeMate

    CoffeeMate Junior Butt Warmer

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    They're all notorious for requiring a resident to sign over any and all income.
     
  8. CountryGun

    CountryGun New Member

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    Wish it were not so, but she's in one of the cheapest around, and like "CoffeeMate" said, they're going to get every penny anyway.
     
  9. mb90535im

    mb90535im Well-Known Member

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    I wouldn't trust advice from just any pharmacist out of concern they would be pushing a particular plan based on how it benefits them, but if you happen to know one you trust you should discuss this with them.

    Maybe when they know exactly what meds your mom is taking, availability of generic brands, etc. they might be able to recommend an alternative prescription insurance supplemental plan that would help close the gap or at least cost less overall than what you're having to pay out of pocket currently.
     
  10. cwats04

    cwats04 Member

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    i know when my dad was dealing with this for my grandmother then smartest thing he did was to hire a medicare lawyer to help deal with all of it. the lawyers retainer was based on an estimated life and seemed very resonable.

    I am sure you could find someone like that in NC that would be able to help you out and figure it all out so that you would no longer have to pay so much out of pocket
     
  11. inkdaddy

    inkdaddy Member

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    CG

    I've been working for Eckerd Drugs/ now Rite Aid Pharmacy for over 20 years. I deal with Medicare/Medicaid patients every day in my new job. Try this link.......I think it may be helpful for you and your Mom. There is a icon for choosing a state.

    Steve

    http://www.riteaid.com/pharmacy/medicare/
     
  12. chainsaw123

    chainsaw123 GPDO Supporter

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    CG,

    My wife is the executive director (boss) at an assisted living in roswell. email me your contact info and I will ask her to call you so you can ask her questions. Her mother and my aunt both live where she works. She might be able to give you some insight.

    email me at kawcubed @ yahoo.com
     
  13. zeebo

    zeebo New Member

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    Typically, Medicare Part D will "reset" at the beginning of the new year, so the good news is that this should be the only month in the doughnut hole. You might have to deal with a deductible come January 1, but this should be considerably smaller than the doughnut hole.

    In the meantime, certainly check the Wal-Mart $4 list. Also Kroger, Kmart, and Rite Aid all have lists with a lot of generics for under 10 dollars that Wal-mart might not have on their list. Some of these guys do deliver, so that might satisfy her home's direct from the pharmacy requirement.

    Also look at possibly changing some of her more expensive name brand drugs. Many newer, more expensive drugs available only have negligible increases in effectiveness or decreases in side effects. These big pharmaceutical companies will reinvent the wheel a hundred times to keep a patent on a drug. Have your mother talk to her doctor about changing these expensive drugs to cheaper generics, if the doctor deems this possible.

    In the future: You will probably run into the doughnut hole every year from now on, plan ahead. Every month your mother's Medicare Part D provider should mail her EOB's (explanation of benefits). These will tell how much money she has until she hits the doughnut hole (or how much money she must pay out of pocket if she is already inside the doughnut hole). Also consider not running some of her cheaper medications on her medicare. For example, at my pharmacy some drugs are as little as $8.99 on our free discount card. If we run the same prescription on Medicare part D we may charge Medicare our usual and customary price of around $30 (for example). You will pay a lower copay (probably around $1) but we charge the $30 towards her Medicare and she is $30 dollars closer to the doughnut hole. Doing little things like this can really add up over a year!

    Drop me a PM if you need more specific help, I love trying to help people get more out of their money when it comes to prescriptions. (That goes for everyone here too!)